Day: 12/02/2014

Project Lazarus

Project Lazarus is not only treating those who suffer from addiction, but is also changing the way chronic pain is treated… one county and city at a time.

http://harmreduction.org/issues/overdose-prevention/tools-best-practices/naloxone-program-case-studies/project-lazarus/

In response to some of the highest drug overdose death rates in the country, Project Lazarus developed a community-based overdose prevention program in Wilkes County and western North Carolina that focused on increasing access to naloxone for prescription opioid users.

Our efforts over the last two years have prevented overdose deaths in Wilkes County. In a publication in Pain Medicine, we report that the overdose death rate dropped 42 percent from 2009 to 2010, with only four overdose deaths confirmed so far in 2011.

Forty-two percent looks like a large number, but not when considering the number of deaths we’re talking about.

Substance abuse related emergency department admissions dropped by 15.3% from 2008 to 2010.

This is the important statistic, and a moderate one at 15.3%, but still not very good considering the amount of regulation, restriction, and effort focused on opioids.

And considering the amount of risk factors assessed and involved before patients are allowed to use naloxone, I’m surprised this drug is helping at all.

As head of an agency [Fred Brason II, president and CEO of Project Lazarus, a nonprofit public health organization established in Wilkes County, N.C.] that works to increase public awareness about responsible pain management policies and provide substance abuse treatment…   to empower communities and individuals to prevent drug overdoses and meet the needs of those living with chronic pain…

We work closely with Community Care of North Carolina’s (CCNC) Chronic Pain Initiative to help deliver better pain relief while reducing overdose risk at the same time. (CCNC is North Carolina’s non-profit Medicaid management entity.) The Chronic Pain Initiative seeks to address these challenges through a broad partnership that includes CCNC, the North Carolina Hospital Association, local hospitals and emergency departments, local health departments, primary care doctors, faith-based programs and law enforcement. CCNC is providing financial support and tapping into CCNC’s local networks – professionals who are expert in local conditions and resources for treatment.

Google identifies Community Care of North Carolina as a “health consultant.”  Translation: management consultants.

http://atforum.com/2014/06/project-lazarus-brings-opioid-treatment-program-to-wilkes-county/

6/2/2014

But the organization, under the guidance of CEO Fred Wells Brason II, was also instrumental in bringing the first opioid treatment program (OTP) to Wilkes County North Carolina. It started as a buprenorphine clinic, which was more palatable to physicians, and then became a full-service OTP including methadone.

“Opioid Treatment Program” — that’s a new term for me.  Might as well be “Chronic Pain Treatment Program.”  Pain patients don’t need to be treated for pain, they need to be treated for opioid addiction.  There, problem solved, according to these kinds of organizations.

In one meeting with them and Jana Burson, MD, from the OTP, one doctor said he didn’t want “those people in the waiting room with Grandma…”

“Those people”?  And this, coming from a doctor?  With a medical degree?  I guess in North Carolina, drug addicts are worse than, what, black people?

The vast majority are on methadone because they cannot afford buprenorphine.

Only Medicaid patients are forced to use the more-dangerous methadone.  (See other articles on this site for information on the dangers of methadone.)

Through a grant from Purdue Pharma, the Lazarus Project was able to provide naloxone kits at no charge to the OTP.

Big Pharma involvement, no surprise there.  No doubt, there is also federal funds supporting this group, but I’m too tired to search for the link.

So far the OTP has documented four lives saved.

Out of how many?

http://www.northcarolinahealthnews.org/2014/02/10/saving-lives-by-preventing-overdose-in-wilkes-county/

2/10/2014

Casey Reeves was one of the 18 people in Wilkes County who died of accidental opioid overdose in 2006.

In no way do I want to discount the number of lives lost, but for an “epidemic,” the number of people we’re talking about is very, very small.

Donna Reeves and her husband didn’t know about naloxone when their daughter died, but they do now. Reeves has helped Brason raise awareness in Wilkes County…  Reeves said Casey probably died because she took the amount of the opioid drug that she’d gotten used to when she was using more frequently. But months of abstinence had lowered her body’s tolerance. Her old “usual” dose was enough to kill her.

Yes, abstinence can lower your body’s tolerance, but I have to wonder if naloxone can also be responsible for changing your brain’s chemistry and therefore creating a potential for overdose.

The unintentional-overdose rate remained high in 2009, when 30 Wilkes County residents died, resulting in a rate of 46.6 per 100,000. But in 2010, the numbers began to fall.  “From 2009 to 2010, there was a 47 percent decrease in the number of deaths,” Brason said. In 2011, it dropped to 13 per 100,000.

Using these big numbers looks impressive, but appearances can be deceiving — which is why so many people use these figures to support whatever they’re selling.

By the end of 2014, the Project Lazarus model of educating patients and physicians will be deployed in all of North Carolina’s 100 counties through North Carolina’s Community Care networks, the organizations that manage the care for most of the state’s Medicaid patients… North Carolina’s military community has also embraced Project Lazarus principles, employing the model policies on Ft. Bragg. Brason also said the Eastern Band of Cherokee Indian Reservation has adopted the full Project Lazarus model, and that they’re seeing results.

I can’t say this enough… CHA CHING!

Brason, Sanford and Donna Reeves have all spoken to officials from federal agencies, including the Food and Drug Administration, to determine what needs to be done to make naloxone more available in community settings.  When he went to the FDA hearings, Brason brought Reeves with him to testify as to the effects of opioid overdose on families and communities.

I’m sorry Mrs. Reeves’ daughter was a victim of the drug war, but using these parents to convince the FDA and Congress to make all of our lives miserable leaves me with little sympathy.

“I think of Casey every day, wondering if she’s proud of me, doing these things,” Reeves said.  “And I think she’s proud of me.”

People will believe whatever they want to justify doing the wrong thing.

Panel: Quashing Prescription Drug Abuse Demands Community Effort

http://www.aafp.org/news/practice-professional-issues/20141202statelegopioids.html

According to Robert Twillman, Ph.D., director of policy and advocacy for the American Academy of Pain Management, of the tens of thousands of prescription drug overdose deaths in the United States each year, more than 75 percent can be attributed to use of multiple drugs. Furthermore, he suggested, the rates of prescription overdose may be higher in recent years because people are misusing more often — not because a greater number of individuals are misusing.

Risk assessment related to an opioid prescription should include assessment of individuals who come in contact with the patient.

Sounds like the AAFP (American Academy of Family Physicians) is advising doctors to hire the FBI to do background checks on pain patients before a prescription is even written.  How would you like your doctor’s office calling all your friends and family to determine if they are safe to be around you while you are treated with pain medication?

Allain cautioned that the intent of the program is to reduce drug diversion and potential overdose or misuse and it should not be interpreted as a law enforcement tool.

Man, who are ya’ll trying to fool?  With DEA involvement, the PDMP should not be “interpreted” as being used for law enforcement?  Huh?  At the beginning of this article, it states:  “The best ways to battle this problem involve cooperation among physicians, pharmacists and law enforcement officers.”

Your doctors and pharmacists are now part of the drug war, part of the DEA, part of state health departments, part of a national tracking database… Seriously, pain patients are being bar-coded, tagged, marked… forever and ever, amen.  As a pain patient, you are no longer a “patient” or a healthcare consumer — you are a potential criminal, addict, and suicide case.  You are a hazard to your community.

The medical industry keeps going full-speed-ahead in the wrong direction and traveling down the wrong road.  And while I like the fact that doctors appear to be destroying their own business and place in society, it’s just plain tragic that pain patients are now on their own.

And how much do you want to bet that Project Lazarus, mentioned in this article, is the same kind of organization as Phoenix House?

What about the children?

The are numerous Google hits for Dr. Kolodny’s speaking engagements, but this one for the Children’s Safety Network (link below) says it all.

Mr. Kolodny wants parents everywhere to be constantly watching their children for signs of drug addiction — as if most kids are potential addicts.  (Pain patients, sound familiar?)  Mr. Kolodny must convince everyone that their kids are in danger of addiction, so he can make money from their treatment.  Do you know how many “rehabilitation” centers he runs?

Mr. Kolodny and the media use the term “nonprofit” to describe Phoenix House, as if that term gives this federally-funded corporation some kind of legitimacy.  As if they help people who suffer from addiction out of the goodness of their hearts. Sure, a nonprofit, I get it — just like the Komen Foundation, the Red Cross, and GPS Crossroads are nonprofits.

http://www.childrenssafetynetwork.org/webinar/overview-opioid-addiction-epidemic

“For New York City, he helped develop and implement multiple programs to improve the health of New Yorkers and save lives, including city-wide buprenorphine programs, naloxone overdose prevention programs and emergency room-based screening, brief intervention and referral to treatment (SBIRT) programs for drug and alcohol misuse.”

If you take opioids and go to the ER for any reason, watch out… You’ll be referred to a “treatment program” before the nurse takes your temperature.  And like I said, tomorrow we’ll look to see if Mr. Kolodny’s programs made a difference, because, it’s funny, but while mentioning his involvement, I haven’t run across a mention of whether the programs were successful or not.

Tomorrow…

What’s the drug/opioid epidemic look like in France?

Part of the reason buprenorphine (Suboxone, etc.) is being pushed in the U.S. is because France tried this experiment first.

France approved buprenorphine in 1996, and in 2010, reported “a five-fold reduction in overdose deaths and a sixty-fold drop in the number of active injection drug users.”  (As in the U.S., figures are always 2 or 3 years behind the current year.)  (France has free needle exchanges and similar progressive programs.)  But just like Dr. Kolodny’s corporation, Phoenix House, France began by offering “treatment” instead of jail to victims of the drug war, including the use of buprenorphine to treat substance abuse and addiction.  So, shall we see how France is doing?

Selected excerpts from:  http://www.emcdda.europa.eu/publications/country-overviews/fr

The number of drug-induced deaths showed a constant increase between 2003 and 2010, and were mainly attributed to deaths due to heroin and methadone overdoses. In 2011, based on the General Mortality Register, 340 drug-induced deaths were recorded, a reduction from the 392 cases reported in 2010. In 2011 the majority of victims were male (249 cases). The mean age of the deceased was 45.7 years (significantly higher for females than for males). Toxicological data available from the Special Mortality Register (SR) indicates that opioids prevail, mainly methadone or buprenorphine, alone or in combination with other psychoactive substance. Opioids were involved in more than three-quarters of deaths recorded in the SR.

Since 1995 opioid substitution treatment (OST) has constituted the main form of treatment for opiate users, and has been integrated into a total therapeutic strategy for drug dependence, including for drug users in prison. Methadone and HDB [buprenorphine] are used for OST, though HDB, introduced in 1996, is still the most widely prescribed substitution substance. In rare cases, morphine sulphate is provided as substitution. Several directives regulate the dose, place of delivery and duration of OST.

France is a transit area for illicit drugs smuggled to the Netherlands, Belgium, the United Kingdom and Italy. As in most European Union countries, cannabis is the most widely available and accessible of all illicit substances… In 2010 a total of 157,341 drug-law offences were reported, of which 87.5 % were cannabis-related, 6.8 % heroin-related and 4.1 % cocaine-related.

Among all treatment clients, 44 % reported cannabis as their primary drug, followed by 43 % for opioids and 6 % for cocaine. Among new treatment clients, 63 % reported cannabis as their primary drug, followed by 27 % for opioids (mainly heroin) and 4 % for cocaine.

The high number and proportion of cannabis users among treatment demand clients in France is related to several factors — the establishment some years ago of specialised consultation centres for young users, mainly cannabis users, and of CSAPAs, and the fact that cannabis also remains the main drug in court-ordered treatment cases.

Following a period of policy development, France’s new Government Plan for Combating Drugs and Addictive Behaviours 2013–17 was launched on 19 September 2013. It takes a comprehensive and global approach towards illicit and licit drugs (narcotics, alcohol, tobacco, psychotropic medicines and new synthetic products) and other forms of addictions (gambling, gaming, doping)… The prevention of drug, alcohol or psychotropic use in the workplace, incorporating the use of screening, has been a priority for occupational physicians since 2012… Moreover, since 2005 some 300 youth addiction outpatient clinics (CJCs) have been opened throughout France to carry out ‘early intervention’.

Funny how the drug war has created similar victims all over the world. The strategy that France and Phoenix House are using — offering “treatment” instead of jail, especially for young people — doesn’t appear to be working.  At least for the victims, who are forever labeled as drug addicts. And all the cannabis users (who may have a potential addiction rate of about 3%) are now introduced to a bunch of people with serious drug problems. Drugs don’t have the stigma for young people that they do for older folks, so I imagine there’s a good-sized underground drug market for people who suffer from addiction — and for a large number of people who don’t, or didn’t before they were forced into these programs.

Governments in both countries introduced buprenorphine, which increased access and use of this drug — which, coincidentally, also increased the instances of abuse and overdoses involving buprenorphine.  And in France, along with methadone, buprenorphine is the opioid that’s causing the most damage.

Because general practitioners in the U.S. don’t want to treat drug addicts, sales of buprenorphine are small compared to France (which is how this drug is mostly distributed in that country). But, thanks to Dr. Kolodny, pretty soon, when it comes to buprenorphine, America will look worse than France.

The good news is that it looks like French citizens have turned to cannabis, when they are able to, and that legalizing medical cannabis in that country would really help.

Since Dr. Kolodny last worked in Brooklyn, NY, tomorrow we’ll look into what damage the drug war is doing in that state. Sound like fun?

11/30/2014, Christian-based Tampa homeless program forces destitute to work for free

This is what the drug rehabilitation industry looks like (if you’re poor)…

http://www.rawstory.com/rs/2014/11/christian-based-tampa-homeless-program-forces-destitute-to-work-for-free/comments/

“Atchison, who claims to have a doctorate in theology he earned from a now defunct online school, is currently applying to run Hillsborough County’s new homeless shelter with a contract worth millions of public dollars.”